Measuring the level and determinants of health system efficiency in Canada / : Mesurer l'efficacité du système de santé canadien et ses déterminants

In recent years, public discourse on the performance of the Canadian health system has shifted from increasing the available resources to making better use of those resources. The goal of this study is to measure health system efficiency in Canada and to examine the factors that help explain variations in estimates of efficiency across the health regions. Here, the term "health system" refers to all activities under the jurisdiction of provincial and territorial ministries of health. This study uses data envelopment analysis (DEA) to estimate efficiency at the regional level and then undertakes exploratory statistical analysis to examine the factors related to variations in health system efficiency. To determine the health system's objective against which efficiency is measured, a scoping review of official statements of health system objectives, a series of stakeholder consultations and a dialogue among health system leaders were carried out. The health system's objective is for Canadians to have access to timely and effective health care when they are sick or need care. In the current study, this objective was measured as the reduction in potential years of life lost (PYLL) from treatable causes of death. The health system resources used to achieve this objective were measured as the five major components of health spending: hospitals, physician services, pharmaceuticals, residential care facilities and community care.